Financial pressure continues to intensify across the healthcare ecosystem, with health plans at the epicenter. Employers are facing premium increases, and consumers are absorbing higher out-of-pocket costs. At the same time, payers must balance affordability, regulatory demands and rising expectations for seamless digital experiences.
To better understand emerging trends, priorities and challenges across the healthcare financial landscape, Zelis commissioned Datos Insights to survey more than 2,200 healthcare constituents in the first half of 2025 — including 202 health plan executives, 839 employer benefits leaders and 1,226 insured consumers. The resulting six-part research series offers health plans a clearer view of how stakeholders perceive the financial healthcare experience, and where plans can act to improve transparency, digital engagement and cost management.
Across the findings, one theme stands out: care is more than clinical. For health plans, it extends into coverage clarity, billing transparency and the financial systems that shape what happens after care is delivered. These moments directly influence member trust, employer satisfaction, and provider relationships.
Transparency as a Strategic Lever
For payers, transparency has evolved from a compliance requirement to a competitive differentiator.
Employers increasingly view price transparency as a primary cost-management strategy, with 63% ranking it as very important. Nearly half (48%) cite rising costs as their top challenge during benefits renewal. Meanwhile, 68% of consumers report cost increases over the past two to three years, intensifying demand for tools that allow them to compare prices and plan ahead.
For health plans, this convergence presents both pressure and opportunity.
Consumers want clear cost information before care so they can make informed decisions. Employers want transparency to drive value. Plans that embed transparency across the financial journey, from estimates to billing, can reduce confusion, improve member satisfaction and strengthen employer relationships.
For payers seeking to stay ahead, the research makes clear that transparency must translate into actionable, real-time insights for members and employers — not just publicly available pricing data.
Bridging the Digital Divide
The survey also highlights a generational shift in how members interact with healthcare.
Gen Z and Millennials — digital natives — approach healthcare like other consumer services: searchable, comparable and optimized. Seventy-three percent of Gen Z and 69% of Millennials report using cost-management tools like price comparison platforms and digital cost estimators when available. By contrast, only 49% of Baby Boomers use these tools.
For payers, the takeaway is clear: digital tools must be both accessible and intuitive.
Only 39% of members report positive billing experiences. Half say they lack access to cost transparency tools altogether. Low-cost medication guidance and incentives for cost-effective care are even less common.
Health plans can improve engagement and satisfaction by streamlining payments, embedding HSA and FSA functionality directly into the payment flow, and expanding access to intuitive cost-management tools. When digital experiences reduce friction, members feel more in control and trust in the plan increases.
Payment Integrity: A Proving Ground for AI
Artificial intelligence is rapidly moving from experimentation to execution, particularly with health plans.
Seventy-one percent of surveyed payers report actively using AI, with nearly half piloting expanded use cases and 23% embedding AI as a central operational component.
Administrative functions — particularly claims management and payment integrity — are emerging as high-impact applications. Sixty percent of payers report improved claims accuracy through AI adoption.
For payers, payment integrity has become a proving ground for AI investment. Faster identification of inaccuracies, reduced manual effort and improved precision strengthen financial performance and enhance provider relationships and operational efficiency. In this context, speed and accuracy are more than operational goals — they are strategic advantages.
A New Era of Employer–Payer Collaboration
As employers confront rising costs, many are layering analytics, plan design innovation and digital engagement strategies to manage both financial performance and employee experience.
This creates an opportunity for deeper collaboration between employers and health plans.
Shared data, integrated transparency tools and measurable ROI reporting are becoming central to employer–payer partnership strategies. For health plans, aligning digital tools and financial insights across the care journey can drive higher adoption, improve plan performance and demonstrate measurable value to employer clients.
Health plans that proactively support employer cost-containment strategies position themselves as strategic partners — not just administrators.
Looking Ahead
Policy changes and continued cost pressures will keep the healthcare financial landscape complex. But for health plans, complexity can create opportunity.
Payers that prioritize transparency, modernize payment processes and deploy intelligent automation thoughtfully will be best positioned to lead.
The path forward is not simply about cost containment or regulatory compliance. It is about transforming the healthcare financial experience in ways that improve trust, strengthen employer relationships and deliver sustainable value.
For health plans willing to align stakeholder insights with modern digital capabilities, the research offers a clear roadmap.
